Addie Shock, | |
125 E Broad St Ste 302, Elyria, OH 44035-6447 | |
(440) 323-0258 | |
Not Available |
Full Name | Addie Shock |
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Gender | Female |
Speciality | Nurse Practitioner - Pediatrics |
Location | 125 E Broad St Ste 302, Elyria, Ohio |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1215380423 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363LP0200X | Nurse Practitioner - Pediatrics | RN3810151 (Ohio) | Primary |
Entity Name | The Cleveland Clinic Foundation |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1679525919 PECOS PAC ID: 1850203555 Enrollment ID: O20031103000049 |
Entity Name | Lorain County Health & Dentistry |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1215194527 PECOS PAC ID: 9234047853 Enrollment ID: O20031105000774 |
Mailing Address | Practice Location Address |
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Addie Shock, 9807 Nicole Ln, Olmsted Twp, OH 44138-4252 Ph: (419) 685-4353 | Addie Shock, 125 E Broad St Ste 302, Elyria, OH 44035-6447 Ph: (440) 323-0258 |
Bretzyl M Liscoe, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 630 E River St, Elyria, OH 44035 Phone: 440-323-8515 | |
Nicole Fatemeh Scavuzzo, CNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 525 Chestnut Commons Dr, Elyria, OH 44035 Phone: 440-406-8153 Fax: 440-406-8312 | |
Mary Lauretta Gilchrist, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 630 E River St, Elyria, OH 44035 Phone: 440-329-7500 | |
Ms. Amy M. King, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 630 E River St, Elyria, OH 44035 Phone: 440-329-7500 | |
Amy M Kovalsky, RN, CNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 630 E River St, Elyria, OH 44035 Phone: 440-329-7500 | |
Mrs. Brenda J Life, CNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 125 E Broad St, Suite 305, Elyria, OH 44035 Phone: 440-326-4120 Fax: 440-322-3454 | |
Teneisha Taquae Craighead, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 630 E River St, Elyria, OH 44035 Phone: 440-452-0740 |